Eye Exercises for Treatment of Idiopathic Cranial Nerve VII Paresis: Pilot Study

Abstract

1 . Loss of facial nerve function leads to facial disfigurement, increased salivation, alteration of taste as well as ocular complications. Decreased orbicularis oculi muscle strength can lead to ocular surface and eyelid problems such as epiphora, lagophthalmos, paralytic ectropion and exposure keratopathy. Loss of corneal protection can lead to corneal ulceration and potential blindness if treatment is delayed 2 . Treatment usually consists of a combination of eye lubrication, eyelid taping and, in severe cases, a tarsorrhaphy.Cranial nerve VII (CN VII) paresis occurs with an incidence of approximately 20.2 cases per 100,000 people per year 3 . It can occur at any age but the highest incidence is in people between 15-45 years of age 4 . Cranial Nerve VII paresis typically has a sudden onset (i.e. within 24 hours) and its progression can be followed during the first seven to ten days. A large, observational study conducted in Copenhagen studied the natural history of 1,701 patients with CN VII paresis by examining patients weekly for the first six months and then monthly for the following six months. The CN VII paresis was diagnosed ABSTRACT: Background: To determine if fine-motor eye exercises can be used for treatment of unilateral, idiopathic cranial nerve VII paresis to improve rate of recovery. Methods: In this prospective, randomized controlled trial, eligible patients were randomized to perform fine-motor eye exercises (n=18) or to do no exercise (n=9) for a period of four weeks. Orbicularis oculi muscle strength was measured in paretic and unaffected eyes at baseline, two weeks and four weeks using an Orbicularis Oculi Pressure Sensor. Results: The average initial strength of the paretic orbicularis oculi muscle was 34±10 mm Hg compared to the unaffected muscle which was 103±17 mm Hg at baseline (n=27). By four weeks, patients who performed eye exercises improved more than those who did not (74.4 versus 47.4 mm Hg, p=0.029). While there was some loss to follow-up, 63.8% of patients performing exercises (7/11) achieved functional recovery at four weeks compared to 12.5% (1/8) of those who did not (p=0.059). Steroids and antivirals were found to have independent positive effects on improving functional outcome. Conclusions: Eye exercises have a potential role in the treatment of idiopathic cranial nerve VII paresis and warrant consideration in the management of these patients.RÉSUMÉ: Exercices oculaires dans le traitement de la paralysie idiopathique du VIIe nerf crânien : une étude pilote. Contexte : Le but de l'étude était de déterminer si les exercices oculaires de motricité fine peuvent être utilisés pour traiter la paralysie du VIIe nerf crânien afin d'améliorer le taux de guérison. Méthode : Les patients éligibles à cette étude prospective, randomisée et contrôlée, ont fait soit des exercices oculaires de motricité fine (n = 18) ou aucun exercice (n = 9) pendant quatre semaines. La force du muscle orbiculaire de l'oeil a été mesurée au niveau de l'oeil parétique et de l'oeil normal avant l'intervent...

Physical therapy for facial nerve paralysis (Bell's palsy): An updated and extended systematic review of the evidence for facial exercise therapy

“…47 Characteristics of included studies: The 19 individual studies shown in Table 2 included, seven randomised controlled trials (total no. of subjects = 354); one quasi-experimental study (n = 16 patients) 48 ; two pilot studies (n = 37 patients) 49,50 ; and nine non-experimental observational studies (n = 447 patients). Observational studies varied in High their design: three were cohort studies (n = 169 patients) [51][52][53] ; two were retrospective studies (n = 101 patients) 54,55 ; three used group comparisons (n = 164 patients) [56][57][58] ; and one a small clinical study of 13 patients.…”

“…Two were randomised trials, 57 , 66 one was a quasi-experimental study, 48 and two were small pilot studies. 49 , 50 In terms of methodological flaws all, except one study, 60 were at risk of bias for failing to blind participants when outcomes were based on patient-reported measures. One high-quality study failed to achieve the required sample size, with a significant number of severe facial palsy patients in the control group dropping out in order to access physical therapy which was shown to be improving outcomes.…”

“… 53 , 57 , 59 Others focused on the severity of facial palsy; this ranged from Grade II to VII. 50 , 52 , 58 , 62 , 64 …”

“…53,58 The effectiveness of facial exercise therapy on its own was evaluated in only two studies; both reported that patients performing facial exercises achieved greater functional recovery than those who did not. 50,55 Six studies assessed physical therapy combined with biofeedback, either via a mirror or other means; all reported positive improvements. 49,[51][52][53][54]66 The remaining 10 studies evaluated the effectiveness of combining facial exercise therapy with corticosteroids, 58,61,62 botulinum toxin, 57,59,64 electrical stimulation, 48,63 or laser treatment.…”

Eye Exercises Enhance Accuracy and Letter Recognition, but Not Reaction Time, in a Modified Rapid Serial Visual Presentation Task

“…Eye exercises are also practiced to enhance sports performance and used during yoga to promote general well-being [2]. However, few studies exist on evaluating the outcomes and efficacy of this type of therapy [1], [3]–[9]. One such study found a measurable effect of eye exercise in patients with convergence problems [10].…”